title: Diagnostic value of endothelial markers and HHV-8 staining in gastrointestinal Kaposi sarcoma and its difference in endoscopic tumor staging.
abstract: OBJECTIVE
  To clarify the diagnostic values of hematoxylin and eosin (HE), D2-40, CD31, CD34, and HHV-8 immunohistochemical (IHC) staining in gastrointestinal Kaposi's sarcoma (GI-KS) in relation to endoscopic tumor staging.
  
  
  METHODS
  Biopsy samples (n = 133) from 41 human immunodeficiency virus-infected patients were reviewed. GI-KS was defined as histologically negative for other GI diseases and as a positive clinical response to KS therapy. The receiver operating characteristic area under the curve (ROC-AUC) was compared in relation to lesion size, GI location, and macroscopic appearances on endoscopy.
  
  
  RESULTS
  GI-KS was confirmed in 84 lesions (81.6%). Other endoscopic findings were polyps (n = 9), inflammation (n = 4), malignant lymphoma (n = 4), and condyloma (n = 2), which mimicked GI-KS on endoscopy. ROC-AUC of HE, D2-40, blood vessel markers, and HHV-8 showed results of 0.83, 0.89, 0.80, and 0.82, respectively. For IHC staining, the ROC-AUC of D2-40 was significantly higher (P < 0.05) than that of HE staining only. In the analysis of endoscopic appearance, the ROC-AUC of HE and IHC showed a tendency toward an increase in tumor staging (e.g., small to large, patches, and polypoid to SMT appearance). D2-40 was significantly (P < 0.05) advantageous in the upper GI tract and for polypoid appearance compared with HE staining.
  
  
  CONCLUSIONS
  The diagnostic value of endothelial markers and HHV-8 staining was found to be high, and its accuracy tended to increase with endoscopic tumor staging. D2-40 will be useful for complementing HE staining in the diagnosis of GI-KS, especially in the upper GI tract and for polypoid appearance.
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan. nnagata_ncgm@yahoo.co.jp
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.forename: Toru
authors.initials: T
authors.lastname: Igari
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Katsunori
authors.initials: K
authors.lastname: Sekine
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.forename: Yohei
authors.initials: Y
authors.lastname: Hamada
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Yazaki
authors.forename: Norio
authors.initials: N
authors.lastname: Ohmagari
authors.forename: Katsuji
authors.initials: K
authors.lastname: Teruya
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived; D018952:Antigens, CD34 / Q000032:analysis; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000032:analysis*; D001706:Biopsy; D004396:Coloring Agents; D016099:Endoscopy, Gastrointestinal; D042783:Endothelial Cells / Q000737:chemistry*; D004801:Eosine Yellowish-(YS); D005770:Gastrointestinal Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D006416:Hematoxylin; D019288:Herpesvirus 8, Human / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D009367:Neoplasm Staging; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000032:analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D013194:Staining and Labeling
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018952:Antigens, CD34; D014408:Biomarkers, Tumor; D004396:Coloring Agents; D019408:Platelet Endothelial Cell Adhesion Molecule-1; C500987:monoclonal antibody D2-40; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin
keywords: CD31; CD34; D2-40; Gastrointestinal Kaposi’s sarcoma; Hematoxylin and eosin; Human herpesvirus-8